Paediatric Intensive Care Clinical Guidelines

These guidelines have been written primarily for use in the Paediatric Intensive Care Unit of Starship Children's Hospital.  Please see our disclaimer. You can access the PICU drug calculator here. Tools for calculating height, weight and BMI centiles can be found here. To find out more about what we do, see About Us

• A

  • Abdominal pressure monitoring for a child

    Links to ADHB Nursing Policy

  • Updated May 2006 Admission and Discharge in PICU
  • Airway - emergency intubation checklist (pdf, 197.00KB)
  • Airway - intubation (difficult)
  • Updated Jul 2017 Anaesthesia - introduction to anaesthetic drugs
  • Anaesthesia - pre-operative feeding guidelines
  • Anaesthetic department protocols
  • Updated Dec 2015 Anaphylaxis in PICU
  • Antibiotic duration (Australasian Society for Infectious Diseases
  • Antibiotic prophylaxis for cardiac patients in PICU
  • Updated Nov 2011 Antibiotics in PICU
  • Anticoagulation for Cavopulmonary Aortopulmonary Shunts, Valves and Fontans
  • Updated Jun 2018 Arterial line insertion and management
  • Updated Jun 2011 Asthma, life threatening - management in intensive care setting

• B

  • Blood product guidelines - possible DiGeorge syndrome
  • Blood products - massive transfusion (pdf, 68.41KB)
  • Blood products - NZ Blood Service
  • Blood products - transfusion medicine handbook

    ADHB Intranet - for ADHB staff only

  • Blood resources

    For ADHB staff only

  • Blood sampling in PICU (pdf, 94.53KB)
  • Bowel protocol in PICU (pdf, 49.65KB)
  • Updated Sep 2017 Bronchiolitis - PICU admission
  • Updated Feb 2018 Buzzy Bee® - guideline for usage

    For pain relief and distraction for children undergoing painful procedures

• C

  • Cardiac - antimicrobial prophylaxis
  • Cardiac - pacing wire removal in PICU
  • Cardiac - tachyarrhythmia in infants and children
  • Cardiac - temporary pacemaker
  • Updated Mar 2018 Cardiac arrest - investigation of unexplained
  • Updated Oct 2011 Cardiac handover to PICU
  • Cardiac patient care in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Cardiac surgery - pre-operative anti-staphylococcal bundle
  • Updated Jan 2008 Cardiac transplantation
  • Cardiology guidelines
  • Cardiomyopathy
  • Updated Mar 2013 Central line associated bacteraemia (CLAB) high risk criteria and management
  • Updated Jun 2018 Central venous access in PICU
  • Updated Oct 2005 Cervical spine assessment in PICU
  • Updated Mar 2015 Chest drain removal protocol in PICU - Analgesia
  • Updated Jun 2018 Chest drain removal protocol in PICU - EXACT Pathway

    This protocol only applies to patients who are extubated on the EXACT 2 hour pathway

  • Chylothorax - algorithm for management in the cardiac patient
  • Clonidine (transdermal)
  • Code Blue (resuscitation of children)

    Links to ADHB Policy

  • Code Pink (paediatric emergency but not resuscitation)

    Links to ADHB Policy

  • Updated Dec 2016 Congenital diaphragmatic hernia - postnatal management
  • Coroner - Coronial Flow Chart (pdf, 203.89KB)
  • Updated Jul 2017 Croup - management in the intensive care setting

• D

  • Updated Oct 2018 Death of a child in PICU - documentation
  • Diabetic Ketoacidosis
  • Discharge from PICU
  • Drug calculator
  • Drug chart - IV infusion greater than or equal to 30kg
  • Drug chart - IV infusion less than 30kg

• E

  • ECMO - Heparin Infusion
  • Updated Aug 2017 ECMO retrieval - preparation for referring centre prior to arrival
  • End of life - documentation and process
  • Endotracheal tube care in PICU - nursing Guidelines

    Links to ADHB Nursing Guideline

  • Equipment supplies in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • EXACT pathway for early extubation (pdf, 70.38KB)
  • External ventricular drain - nursing guideline

    Links to ADHB Nursing Guideline

  • Extracorporeal Life Support - nursing guideline

    Links to ADHB Nursing Guideline

  • Extracorporeal Life Support Organisation Guidelines (ELSO)
  • Updated Dec 2016 Extravasation and Infiltration Injuries - management in PICU
  • Eye care in PICU - nursing guideline

    Links to ADHB Nursing Guideline

• F

  • Feeding - algorithm for single ventricle infants
  • Feeding - basic information on formulas (pdf, 29.47KB)
  • Feeding - breastmilk and enteral feeding hang times (pdf, 33.63KB)
  • Feeding - enteral feeding guidelines in PICU (pdf, 46.65KB)
  • Updated Sep 2018 Feeding - Pre-operative guideline for PICU patients going to the OR

• G

  • Gastrostomy

    Links to ADHB Policy

• H

  • Haemofiltration - greater than 50kg protocol (pdf, 358.02KB)
  • Haemofiltration - less than 50kg protocol (pdf, 605.40KB)
  • Updated Sep 2007 Haemolytic Uraemic Syndrome
  • Updated May 2010 HDU - Guidelines for admission
  • Updated Oct 2016 Head injury - management of severe traumatic brain injury in PICU

    Management of severe traumatic brain injury with a GCS < 8)

  • Head injury - raised intra-cranial pressure management (pdf, 166.61KB)
  • Updated Apr 2010 Heparin - full dose therapy in children
  • Updated Nov 2018 Heparin - low dose therapy in children
  • Heparin - low molecular weight heparin

    Links to Starship Clinical Guideline

  • Updated Oct 2005 Heparin infusion for ECMO/VAD
  • Updated Jun 2012 High Flow Nasal Cannula
  • High Frequency Oscillation Ventilation (HFOV) in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Updated Sep 2016 Hyperglycaemia in PICU
  • Hyperkalemia treatment

    Links to Starship Clinical Guideline

  • Updated Oct 2016 Hypoxic Ischaemic Encephalopathy (HIE) - management

• I

  • Immunisation register

    NIR website - requires log in to access information

  • Immunisation schedule for NZ children

    Links to latest Ministry of Health immunisation schedule

  • Updated Aug 2012 Immunodeficiency - basic tests
  • Inotrope infusion in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Insertion of invasive lines
  • Intra-abdominal pressure monitoring - nursing guideline

    Links to ADHB Nursing Guideline

  • Intravenous Immunoglobulin (IVIG) therapy

    Links to Starship Clinical Guideline

  • Intubation - difficult
  • Intubation - emergency checklist (pdf, 197.00KB)
  • Invasive haemodynamic pressure monitoring in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Updated Sep 2010 Investigations in PICU
  • Updated Aug 2009 IV Fluids in PICU
  • IV Infusion - drug chart greater than or equal to 30kg (pdf, 71.91KB)
  • IV Infusion - drug chart less than 30kg (pdf, 199.55KB)

• L

  • Updated May 2015 LA and PA Catheters in PICU
  • Liver - acute liver failure (paediatric)

    ADHB only

  • Liver - chronic liver failure (paediatric)

    Chronic liver disease complications - ADHB only

  • Liver transplant - blood ordering pre-op

    ADHB only

  • Liver transplant - immunosuppression (paediatric)

    ADHB only

  • Liver transplant - post operative complications (paediatric)

    ADHB only

  • Liver transplant - post operative routine care

    ADHB only

  • Liver transplant - pre-operative evaluation

    ADHB only

  • Liver transplant - recipient selection

    ADHB only

• M

  • Malignant hyperthermia

    Links to ADHB policy

  • Updated Aug 2012 Microbiological testing in PICU
  • Morphine - intermittent IV administration
  • Updated Apr 2006 MRI - procedure for booking MRI in PICU

• N

  • Updated Mar 2018 Nasogastric tubes in postoperative cardiac patients
  • Needlestick Injuries

    Links to Starship Clinical Guidelines

  • Neonates - caloric calculator

    Links to NICU guidelines. For caloric requirements see the anthropometry calculator

  • New Zealand Resuscitation Council Guidelines

    Links to the ANZCOR Guidelines and Algorithms

  • New Zealand Resuscitation Council Paediatric Resuscitation Flowchart
  • NICU guidelines and protocols

    Links to NICU Website

  • Nitric Oxide in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Updated Oct 2005 Non Accidental Injury (NAI)
  • Nursing guidelines (ADHB Only)

    Links to Policies and Guidelines library on ADHB intranet

• O

  • Updated Jun 2016 Oncology - care of the oncology patient admitted to PICU - blood testing and blood product transfusion
  • Updated Jun 2016 Oncology - care of the oncology patient admitted to PICU - drugs
  • Updated Jun 2016 Oncology - care of the oncology patient admitted to PICU - general principles
  • Updated Jun 2016 Oncology - care of the oncology patient admitted to PICU - intravenous lines
  • Updated Jun 2016 Oncology - care of the oncology patient admitted to PICU with febrile neutropenia
  • Updated Jun 2016 Oncology - care of the oncology patient admitted to PICU with persistent fever
  • Oncology - febrile neutropenia guideline

    Links to NCCN guideline on febrile neutropenia

  • Oncology/haematology - low molecular weight heparin (excluding enoxparain/clexane)
  • Oncology/Haematology protocols within Starship

    On intranet only - for ADHB staff

  • Oral hygiene in PICU - nursing guideline

    Links to ADHB Nursing Guideline

• P

  • Updated Nov 2018 Pacing wires - removal in PICU
  • Pain management - analgesia overview
  • Pain management - Buzzy Bee®
  • Updated Oct 2005 Pain management - epidural analgesia infusion in PICU
  • Pain management - epidural and caudal infusions
  • Pain management - pain service referral for a child
  • Pain management - patient controlled analgesia (PCA)
  • Updated Jun 2010 Pain management - patients discharged from PICU on continuous infusion, PCA or Epidural
  • Pain management - regional infusions
  • Updated Mar 2018 Paracetamol and Ibuprofen dosing
  • Patient at risk (PaR) - Code Blue
  • Patient at risk (PaR) - Code Pink
  • Patient at risk (PaR) - Consultant notification
  • Patient at risk (PaR) - Emergency Equipment
  • Patient at risk (PaR) - Escalation of care
  • Patient at risk (PaR) - Observation and monitoring
  • Patient at risk (PaR) - Paediatric Emergency Response Team
  • Patient at risk (PaR) - Paediatric Trauma Call
  • Peritoneal dialysis in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Pharmacy Standing Orders

    Links to the ADHB Intranet - for ADHB staff only

  • Pressure injury prevention - nursing guideline

    Links to ADHB Nursing Guideline

• R

  • Renal Failure Dosing (GOSH guideline)

    Lilnks to Great Ormond Street clinical guideline

  • Renal policies and guidelines

    This link is for ADHB staff only. You will need to copy and paste the following link to the ADHB intranet page: \\ahsl2\main\Groups\Everyone\Paediatric Nephrology\Medical References and Guidelines\Renal Translant Protocols

• S

  • Sedation & Analgesia - 0-12 month intubated and ventilated (pdf, 28.21KB)
  • Sedation & Analgesia - 0-12 month unintubated (pdf, 30.82KB)
  • Sedation & Analgesia - greater than 12 months and less than or equal to 30kg unintubated (pdf, 29.06KB)
  • Sedation & Analgesia - greater than 12 months and less than or equal to 30kg intubated and ventilated (pdf, 32.16KB)
  • Sedation & Analgesia - greater than 30kg intubated and ventilated (pdf, 27.42KB)
  • Sedation & Analgesia - greater than 30kg unintubated (pdf, 27.40KB)
  • Updated Mar 2015 Sedation & Analgesia - pain and sedation in PICU
  • Updated Mar 2015 Sedation & Analgesia - procedural sedation in PICU
  • Sedation & Analgesia - withdrawal of opioids and benzodiazepines
  • Sedation & Analgesia - withdrawal prescription chart (pdf, 616.07KB)

    Form CR8993

  • Updated Sep 2016 Seizures - status epilepticus in PICU
  • Shift co-ordinator responsibilities in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Skin to skin contact for neonates in PICU

    Nursing guideline for ADHB staff only

  • Spinal injuries in PICU - nursing guideline

    Links to ADHB Nursing Guideline

  • Standing orders - ADHB pharmacy

    For ADHB use only

  • Standing orders - Adrenaline

    ADHB only

  • Standing orders - Ametop

    AHDB only

  • Standing orders - EMLA

    ADHB only

  • Starship Clinical Guidelines
  • Updated Oct 2005 Surgical management of neonates

• T

  • Tachyarrythmia in infants and children
  • Targeted temperature management (pdf, 83.84KB)
  • Total parenteral nutrition (TPN)
  • Tracheostomy management

    Links to ADHB nursing policy

  • Updated Aug 2011 Transport - guidelines for referring hospital preparation
  • Updated Oct 2005 Transport - PICU median transport times
  • Updated Oct 2005 Transport - team preparation and management
  • Transport service - nursing guideline

    Links to ADHB Nursing Guideline

  • Updated Oct 2005 Trauma - initial management in PICU
  • Tuberculosis control guidelines

    Links to the Ministry of Health 2010 guidelines on Tuberculosis control in New Zealand

• U

  • Umbilical catheterisation in NICU

    Links to the Newborn Services Clinical Guideline

  • Updated Feb 2011 Umbilical catheters in PICU

• V

  • Updated Jun 2016 Ventilation - overview of ventilation in PICU
  • Ventilation (non-invasive) - nursing guideline

    Links to ADHB Nursing Guideline

• W

  • Updated Oct 2005 Ward rounds in PICU
  • Withdrawal of analgesia and sedation form (pdf, 616.07KB)
  • Wound care - nursing guideline

    Links to ADHB Nursing Guideline